Secondary non-response

Secondary non-response can occur after an initial beneficial response to anti-TNF therapy. It can result from the development of complications, such as stenosis, that necessitate treatment cessation, or from pharmacokinetic issues such as antibodies against the medication or low serum levels that reduce efficacy.

There is scope to individualise therapy to address secondary non-response. In a review of 614 patients with Crohn's disease treated with infliximab in clinical practice, "interventions" used to maintain response included:2

Reducing the interval between infusions

Increasing the dose of infliximab

Shifting from episodic treatment to scheduled 8-weekly treatment

Measurement of infliximab trough levels and anti-infliximab antibodies can assist in individualising therapy. For example, low trough levels in the absence of antibodies suggest that dose intensification might be effective. If trough levels are high but antibodies are present, it may be beneficial to switch to another agent with the same mechanism of action. If there is still no response to treatment, it may be necessary to switch to an agent with a different mechanism of action.

Summary

Loss of response or no response to anti-TNF therapy can be a primary or secondary phenomenon

Repeated evaluation of patients on biologic therapy can assist in individualising therapy

Dose intensification or alternative therapies may be required in some patients with secondary non-response

Please note, the views expressed in this article are not necessarily those of the sponsor.

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